The Orientation in Space of the Maxillary Arch: New and Old Devices in the Prosthetic Digital Workflow.

Objective: In extensive prosthetic rehabilitations and in those involving the anterior area, a correct 3D spatial position is of fundamental importance for effective communication between the clinician and the dental technician. The aim of this article is to analyze the different methods used to position in space and/or in an articulator the maxillary arch in analog workflows highlighting shortcomings and difficulties in order to understand how to overcome them when employing digital workflows.

Overview: Traditional mechanical devices, such as anatomical, kinematic, esthetic and postural facebows, have clear indications, but also limitations, especially in cases of skeletal asymmetries.

Working Models in the Digital Workflow: Are They Reliable?

Purpose: This position paper summarizes all relevant aspects of the use of working models derived from digital data in digital and hybrid workflows, aiming to (1) provide the reader with a comprehensive review of the types of models that currently can be produced from a digital file created by an intraoral scanner (IOS); (2) critically analyze issues that may undermine or compromise their reliability when requested for the fabrication of both tooth-borne and implant-supported fixed dental prostheses (FDPs); and (3) indicate the procedures to be implemented in order to overcome these issues and produce satisfactory restorations.

Materials And Methods: By way of a thorough literature review, the authors highlight the critical issues of milled and 3D-printed models, solid and alveolar, explaining the differences in terms of accuracy and reliability.

Results And Conclusions: By describing the peculiarities of models with prepared natural teeth and those incorporating metal implant analogs, the clinical indications for their use are given while proposing the strategies that can be adopted to avoid errors during fabrication or to overcome inaccuracies.

Managing Patient Treatment Through Deming's PDCA Cycle: A Standardized Approach in Phases that Adds Value to Dental Care.

This essay is an expert opinion by 3 clinicians who feel the need for a clear phased approach capable of integrating all dental therapies for the care of patients suffering from multiple pathologies of the oral cavity. At the moment, the only guidelines available when treating interdisciplinary cases, i.e.

Contemporary concepts on periodontal complications from prosthetic and restorative therapies.

The clinical outcome of every prosthetic and restorative procedure depends on the maintenance of a healthy periodontium. It is, therefore, important that the prosthodontist and restorative dentist cause no harm or permanent damage to the underlying hard and soft tissues when performing clinical procedures necessary to carry out the planned treatment. Several factors involved in these procedures have been described to have an impact on gingival health.

Digital workflow in implant prosthodontics: The critical aspects for reliable accuracy.

Introduction: This paper is a comprehensive treaty about the variables that influence the transfer of the position of an implant to the laboratory when using a digital workflow.

Objective: The aim is to provide operators and manufacturers with a guide on how to improve certain aspects of the digital workflow specific to the fabrication of implant-supported restorations.

Overview: It addresses intraoral scanning issues and CAD software issues.

A simplified method to develop an interdisciplinary treatment plan: an esthetically and functionally driven approach in three steps.

Many clinicians are unsure of how to develop a comprehensive plan of treatment for patients who present with multiple problems and pathologies. In order to efficiently plan appropriate treatment for such complex patient cases, the clinician needs to either have or develop the necessary knowledge of evidence-based information on the predictability of available clinical procedures. The clinician also needs to understand the correct sequence in which such treatment is applied, and perfect the skills required for carrying out that treatment.

The Influence of Implant Neck Features and Abutment Diameter on Hard and Soft Tissues Around Single Implants Placed in Healed Ridges: Clinical Criteria for Selection.

The clinician's selection of an implant system is influenced by many variables. Ideally, the decision should be based on scientific evidence, but often these decisions are based on economic considerations or influenced by the experience of a trusted peer. The purpose of this paper is to describe the influence of implant neck features (shape and surface) and abutment connection (diameter that matches or is smaller than the implant's platform) on hard and soft tissues around single-tooth implants placed into healed ridges with adequate hard and soft tissue thickness.

Clinical Considerations on Strategies That Avoid Multiple Connections and Disconnections of Implant Abutments.

Typically, healing or temporary abutments are connected and disconnected several times between implant placement and definitive restoration delivery, and soft tissue disruption occurs each time the abutment is disconnected and reconnected. This histologic event is supposed to cause bone resorption around the implant after second-stage surgery. To minimize this clinical scenario, immediately placing and never removing a definitive abutment the day of implant insertion (one-stage protocol) or at second-stage surgery in cases of submerged implants (two-stage protocol) was suggested.

Internal- vs External-Connection Single Implants: A Retrospective Study in an Italian Population Treated by Certified Prosthodontists.

Purpose: The design of an implant connection that allows prosthetic suprastructures to be attached to implants has long been debated in the dental literature. The goal of this retrospective study was to evaluate the 5-year clinical results for a large number of single implants restored by certified prosthodontists in an attempt to establish whether different clinical outcomes could be detected for external- or internal-connection implants.

Materials And Methods: All single implants with internal or external connections inserted in 27 private dental practices from January 1, 2003 to December 31, 2007 were evaluated.

Eleven-Year Retrospective Survival Study of 275 Veneered Lithium Disilicate Single Crowns.

The aim of the present clinical retrospective study was to evaluate the long-term survival and clinical performance of veneered lithium disilicate single restorations in anterior and posterior areas after up to 11 years. Following a rigid protocol, 275 lithium disilicate single crowns (35 IPS Empress II and 240 e.max Press) were cemented over 11 years, in 106 patients, using an adhesive technique; of these 106 were anterior (38.

A new classification system for all-ceramic and ceramic-like restorative materials.

Classification systems for all-ceramic materials are useful for communication and educational purposes and warrant continuous revisions and updates to incorporate new materials. This article proposes a classification system for ceramic and ceramic-like restorative materials in an attempt to systematize and include a new class of materials. This new classification system categorizes ceramic restorative materials into three families: (1) glass-matrix ceramics, (2) polycrystalline ceramics, and (3) resin-matrix ceramics.

Efficacy of two site-development procedures for implants in the maxillary esthetic region: a systematic review.

Purpose: The purpose of this systematic review was to identify studies in which either orthodontic extrusion or bone grafting was used prior to single implant placement in the maxillary esthetic zone and to compare the biologic, functional, and esthetic outcomes of these two approaches.

Materials And Methods: An electronic MEDLINE search was conducted by three independent reviewers to identify English-language articles, published in dental journals between January 1992 and August 2013, reporting on single-implant site development accomplished by orthodontic forced eruption of nonrestorable teeth or by bone grafting procedures. The search terms were categorized into four groups comprising a PICO (problem, intervention, comparison, outcome) question.

Aesthetic functional area protection concept for prevention of ceramic chipping with zirconia frameworks.

Chipping of the ceramic veneer is reported as a frequent occurrence when using zirconia-based fixed dental prostheses (FDPs). One possible cause of this complication is the inadequate support of the veneering ceramic by the zirconia substructure. In this article, early clinical observations from patients treated with 96 zirconia-based ceramic single- and multiple-unit FDPs on natural teeth and implants are presented.

Internal vs. external connections for abutments/reconstructions: a systematic review.

Objectives: The objectives of the review were (1) to evaluate the accuracy of implant-level impressions in cases with internal and external connection abutments/reconstructions, and (2) to evaluate the incidence of technical complications of internal and external connection metal- or zirconia-based abutments and single-implant reconstructions.

Materials And Methods: A MEDLINE electronic search was conducted to identify English language publications in dental journals related to each of the two topics by inserting the appropriate keywords. These electronic searches were complemented by a hand search of the January 2009 to January 2012 issues of the following journals: Clinical Oral Implants Research, The Journal of Prosthetic Dentistry, The International Journal of Prosthodontics, The International Journal of Periodontics and Restorative Dentistry, The International Journal of Oral Maxillofacial Implants, Clinical Implant Dentistry and Related Research.

Influence of the 3-D bone-to-implant relationship on esthetics.

There are biologic limits of the soft tissue dimension around implants; therefore, the limiting factor for the esthetic result of implant therapy is the bone level at the implant site. Clinicians must focus on the 3-D bone-to-implant relationship to establish the basis for an ideal and harmonic soft tissue situation that is stable over a long period. In some situations, missing bone is a limiting factor for esthetics; in others, it is possible to regenerate new bone around implants.

Clinical considerations and rationale for the use of simplified instrumentation in occlusal rehabilitation. Part 2: setting of the articulator and occlusal optimization.

In fabricating a prosthetic rehabilitation, whether it consists of just a single crown or a complete-mouth reconstruction, one of the main aims of the clinician is to simplify the procedures and reduce the time necessary to integrate it into the mouth of the patient This article completes the description of the rationale behind the selection of semiadjustable articulators and of a way to transfer to the laboratory technician valuable information that, in the case of extensive rehabilitations, will make occlusal optimization more error free.