Antoanela Garbacea

CAD/CAM fabricated complete dentures: concepts and clinical methods of obtaining required morphological data

The clinical impression procedures described in this article provide a method of recording the morphology of the intaglio and cameo surfaces of complete denture bases and also identify muscular and phonetic locations for the prosthetic teeth. When the CAD/CAM technology for fabricating complete dentures becomes commercially available, it will be possible to scan the denture base morphology and tooth positions recorded with this technique and import those data into a virtual tooth arrangement program where teeth can be articulated and then export the data to a milling device for the fabrication of the complete dentures. A prototype 3-D tooth arrangement program is described in this article that serves as an example of the type of program than can be used to arrange prosthetic teeth virtually as part of the overall CAD/CAM fabrication of complete dentures.

The incidence of maxillary sinus membrane perforation during endoscopically assessed crestal sinus floor elevation: a pilot study.

Transcrestal sinus membrane elevation is a surgical procedure performed to increase the bone volume in the maxillary sinus cavity. Because of visual limitations, the potential for maxillary sinus membrane perforations may be greater than with the lateral approach technique. The aim of this study was to macroscopically investigate ex vivo the occurrence of sinus membrane perforation during surgery using 3 transcrestal sinus floor elevation methods. Twenty fresh human cadaver heads, with 40 intact sinuses, were used for simultaneous sinus membrane elevation, placement of graft material, and dental implants. Real-time sinus endoscopy, periapical digital radiographs, and cone-beam computerized tomography (CBCT) images were subsequently used to evaluate the outcome of each surgical procedure. Perforation rates for each of the 3 techniques were then compared using a significance level of P < .05. No statistically significant differences in the perforation rate (P = .79) were found among the 3 surgical techniques. Although the sinus endoscope noted a higher frequency of perforations at the time of implant placement as compared with instrumentation or graft insertion, the difference was not statistically significant (P = .04). The CBCT readings were judged to be more accurate for identifying evidence of sinus perforations than the periapical radiographs when compared with the direct visualization with the endoscope. This pilot study demonstrated that a sinus membrane perforation can occur at any time during the sinus lift procedure, independent of the surgical method used.

Lateral and crestal bone planing antrostomy: A simplified surgical procedure to reduce the incidence of membrane perforation during maxillary sinus augmentation procedures

This clinical report presents a simplified surgical procedure for accessing the maxillary sinus antrum via lateral and crestal approaches, which reduces the potential for sinus membrane perforation and subsequent complications when graft materials and dental implants are placed into the sinus. Due to visual limitations, perforations and associated complications can jeopardize the success rate of the graft and the implants. While there is a lack of clinical data, clinical observations suggest that the procedure, described by the authors as lateral/crestal bone planing antrostomy, can reduce the possibility of perforation of the maxillary sinus membrane during the lateral and crestal approaches to the grafting of the maxillary sinus floor. The technique involves the use of specially designed rotary instruments that plane away the bone in thinner layers, with less chance of excess bone removal and membrane perforation.

Digitally planned and fabricated mandibular fixed complete dentures. Part 2. Prosthodontic phase.

Part 1 of this patient report described a prosthetically driven protocol that used computer-aided engineering for the fabrication of a mandibular conversion denture and maxillary provisional complete denture using the AvaDent Digital Denture system. The report demonstrated that this system combined with NobelClinician implant-planning software can be used to efficiently convert a digital denture into an immediately loaded provisional implant-supported fixed complete denture (hybrid prosthesis). Part 2 of the patient report describes the technique and steps involved in the fabrication of a digitally planned and fabricated mandibular fixed complete denture with incorporated titanium milled bar opposed by a definitive computer-aided design/computer-assisted manufacture-milled maxillary complete denture.

Use of a Digitally Planned and Fabricated Mandibular Complete Denture for Easy Conversion to an Immediately Loaded Provisional Fixed Complete Denture. Part 1. Planning and Surgical Phase

This article describes a unique prosthetically driven protocol that uses computeraided engineering to develop sophisticated, scientific algorithms that guide the fabrication of a conversion denture using the AvaDent Digital Denture system (Global Dental Science). This system is combined with Nobel Clinician (Nobel Biocare) implant-planning software to optimize accuracy and to make it easier and faster to convert a denture to an immediately loaded provisional implant supported fixed complete denture following implant placement, using a NobelGuide surgical template.

Degree of Patient Pain, Complications, and Satisfaction after Root Canal Treatment or a Single Implant: A Preliminary Prospective Investigation

INTRODUCTION Dentists often face the choice between tooth retention with root canal treatment and tooth replacement with implant treatment. To date, there has not been a prospective clinical trial directly comparing nonsurgical root canal treatment and single delayed implant therapy with regard to the degree of preoperative and postoperative pain, complications, and patient satisfaction. METHODS Twenty-four patients had initial nonsurgical root canal treatment, and another 24 had single implant treatment in healed sites. Questionnaires were given at pretreatment, 7 days, 3 months, 6 months, and 12 months. RESULTS All patients completed the 12-month follow-up period. No significant difference in pain, complications, or overall satisfaction was noted between the 2 groups at any of the time points (P > .05). However, there were differences within each group between the time points. There was more pain at pretreatment for root canal treatment and 7-day post-treatment point for single implant treatment than any other time point. For complications, more were reported at the 7-day post-treatment point than any other time point for both groups. With overall satisfaction, there was no difference from any time point for either group. CONCLUSIONS The results of this study suggest that patients perceive both treatments with high degrees of satisfaction with minimal pain and discomfort. Differences were found at different time points of treatment and were related to the nature of the treatment itself. This information is useful to help patients with treatment decisions.

Patient's own natural teeth as part of the interim prosthesis on immediately placed single implants in a staged surgical approach

A technique is described where the tooths natural crown is used as part of the interim implant supported prosthesis in clinical situations where a tooth with poor prognosis is extracted and an implant is placed immediately after tooth extraction. A preliminary impression is made before tooth extraction, and the exact tooth positioning is assessed in the laboratory as part of the treatment plan. An acrylic resin repositioning jig is fabricated that will guide the clinician in seating and orienting the crown intraorally after implant placement is completed. After the natural tooth is extracted and an implant is immediately placed via guided approach, the extracted natural crown is hollowed and placed on top of an interim abutment. The natural crown is positioned intraorally by using the acrylic resin repositioning jig. The crown is then internally relined and placed as part of the interim implant supported prosthesis. After osseointegration has been confirmed, a definitive prosthesis is placed.

Digital technology for performing a nasopalatine and greater palatine nerve block with a modified implant surgical guide: A technique article

This article describes a computer-aided design and computer-aided manufacturing (CAD-CAM) technique to perform a precise nerve block of the nasopalatine and greater palatine nerves by using an implant surgical guide. The technique uses additional guide anchor pins planned and positioned for specific anatomic landmarks during guided implant surgical guide planning. A relief modification virtually designed on the intaglio surface of the surgical guide allows for palatal soft tissue distension following administration of local anesthetic. This information is then transferred to the guide manufacturer to order the modified guided implant surgical guide. The purpose of this procedure is to provide precise delivery of local anesthetic and to prevent any discrepancy in surgical guide seating following injection.

Using Virtual Ridge Augmentation and 3-Dimensional Printing to Fabricate a Titanium Mesh Positioning Device: A Novel Technique Letter

This technique describes a novel approach for planning and augmenting a large bony defect using a titanium mesh (TiMe). A 3-dimensional (3D) surgical model was virtually created from a cone beam computed tomography (CBCT) and wax-pattern of the final prosthetic outcome. The required bone volume (horizontally and vertically) was digitally augmented and then 3D printed to create a bone model. The 3D model was then used to contour the TiMe in accordance with the digital augmentation. With the contoured / preformed TiMe on the 3D printed model a positioning jig was made to aid the placement of the TiMe as planned during surgery. Although this technique does not impact the final outcome of the augmentation procedure, it allows the clinician to virtually design the augmentation, preform and contour the TiMe, and create a positioning jig reducing surgical time and error.