Kunal Lal

Complete arch implant rehabilitation using subtractive rapid prototyping and porcelain fused to zirconia prosthesis: A clinical report

The applications of various technological advances in implant dentistry and in all aspects of the diagnostic, treatment planning, surgical, and restorative phases are gaining popularity. Additive rapid prototyping and computer-aided design/computer-aided manufacturing (CAD/CAM) technology are used to generate stereolithographic surgical guides and prefabricated interim prostheses to facilitate implant surgery and immediate loading, respectively. Subtractive rapid prototyping is used for fabrication of zirconia frameworks for definitive implant prostheses. This clinical report describes the comprehensive application of these technological advances in implant rehabilitation to optimize surgical and prosthodontic outcomes as well as patient comfort.

Flapless CAD/CAM-guided surgery for staged transition from failing dentition to complete arch implant rehabilitation: a 3-year clinical report.

The transition of patients from failing dentition to complete arch implant rehabilitation often requires that the patient be rendered edentulous and has to wear a complete removable dental prosthesis for varying periods of time. This is objectionable to many patients. A staged treatment approach allows a fixed interim restoration, patient comfort, and prosthodontic control throughout the rehabilitation process. CAD/CAM-guided flapless implant surgery has the advantage of prosthetically driven implant placement and minimal postoperative sequelae. A patient with a failing dentition was treated with this combined protocol and was followed up for 3 years after loading. Implant and prosthesis survival rates were 100%, with no technical complications encountered up to the last recall. The purpose of this clinical report is to describe a combination of CAD/CAM-guided flapless surgery and a staged treatment approach, thereby giving the patient a tooth-supported or implant-supported fixed interim prosthesis during the entire rehabilitation process. The various surgical, laboratory, and prosthetic stages are illustrated for the complete arch prosthetic rehabilitation, and the 3-year follow-up outcome is reported.

Immediate Loading of the Maxilla with Prefabricated Interim Prosthesis Using Interactive Planning Software, and CAD/CAM Rehabilitation with Definitive Zirconia Prosthesis: 2‐Year Clinical Follow‐up

UNLABELLED Immediate loading in implant dentistry has provided several advantages for both patients and clinicians. Recent advances in computer-aided design/computer-aided manufacturing (CAD/CAM) technology, medical imaging and rapid prototyping have added to the armamentarium of implant dentistry in terms of efficiency, accuracy and predictability. Rapid prototyping and CAD/CAM technology are used to fabricate stereolithographic surgical templates for flapless implant placement. In addition to that, this technology is also used for the fabrication of zirconia frameworks. The zirconia-based implant restorations are gaining popularity in implant prosthodontics combining esthetic properties with strength and biocompatibility. The purpose of this article is to illustrate the steps for implant rehabilitation of the edentulous maxilla with zirconia prosthesis and report the 2-year clinical follow-up of novel technological advances in surgical placement, provisionalization and fabrication of a definitive restoration. CLINICAL SIGNIFICANCE A comprehensive approach to full mouth implant rehabilitation using cutting edge technology is illustrated in a simplified manner.

Flapless implant placement: A technique to eliminate the need for a removable interim prosthesis

Computer-guided flapless surgery for implant placement using stereolithographic templates is gaining popularity. The advantages of this surgical protocol are its minimally invasive nature, accuracy of implant placement, predictability, and reduced time required for definitive rehabilitation. One of the disadvantages, however, pertains to complete arch implant rehabilitation. An existing protocol for complete arch flapless computer-guided implant surgery necessitates the patient to be rendered completely edentulous and to wear a removable complete denture for varying periods of time. This may be objectionable to the patient. This article illustrates a technique which uses a modified radiographic template to overcome this limitation. The patient may have a tooth-supported or implant-supported fixed interim prosthesis during the entire rehabilitation process.

Simple technique to transfer occlusal vertical dimension and articulate a definitive implant cast for a full arch implant prosthesis

Papaspyridakos and Lal Papaspyridakos and Lal The dental literature is replete with techniques for registering maxillomandibular relationships and transferring them accurately to the articulator. For edentulous patients receiving implants, several methods have been described for articulating the definitive implant cast at the appropriate occlusal vertical dimension (OVD) in the centric relation (CR) position.1-6 Techniques available for mounting the definitive implant cast on the articulator include record bases with occlusion rims supported by the healing abutments, or screwretained record bases.1,2 Other options involve the use of a duplicated denture with acrylic resin as a custom impression tray, or even a duplicated denture with vinyl polysiloxane (VPS). 3-6 A time-saving chairside technique is presented for the articulation of the implant definitive cast, maintaining the established OVD, and subsequent fabrication of a silicone index to assist in prosthesis design, both performed in a single visit. The existing denture can then be easily converted into an interim fixed prosthesis on the articulator, thus minimizing chair time and increasing patient comfort and satisfaction.

Posterior maxillary segmental osteotomy for the implant reconstruction of a vertically deficient ridge: a 3-year clinical report.

A vertically deficient posterior maxillary edentulous ridge in conjunction with sinus pneumatization or extensive horizontal bone resorption presents significant challenges for implant placement and restoration with an implant-supported fixed prosthesis. Various surgical techniques have been reported for the reconstruction of the vertically deficient posterior maxilla: guided bone regeneration, sinus elevation, block and/or particulate grafting with barrier membranes, and distraction osteogenesis. This clinical report describes the technique, the management of intrasurgical complications, and the 3-year follow-up results of augmenting the vertically deficient posterior maxilla with a segmental osteotomy prior to rehabilitation with an implant-supported fixed prosthesis.

Prosthetic outcomes and survival rates of implants placed with guided flapless surgery using stereolithographic templates: a retrospective study.

Recent technologic advances allow clinicians to place dental implants using computer-generated templates. However, there are limited data regarding treatment outcomes for implants placed using these techniques. The purpose of this retrospective study was to report the 2- to 4-year prosthetic outcomes and survival of dental implants placed by postdoctoral residents with a flapless surgical protocol using computer-based planning and stereolithographic surgical templates. Thirty-six patients were treated using the NobelGuide concept, comprising an image-based three-dimensional implant planning software and flapless implant surgery with stereolithographic templates.

Use of Vacuum-Formed Templates to Guide Tooth Preparation and Insertion of Interim Restorations

Ideal tooth preparation and interim prostheses are critical to a predictable esthetic and functional outcome in the treatment of full-mouth-fixed restorations. During the treatment stages, multiple procedures need to be considered for a successful and predictable outcome. These include the parallel preparation of multiple abutment teeth followed by the relining of the interim prostheses. The purpose of this article is to describe a technique to simplify tooth preparation and facilitate subsequent insertion of a complete-arch-fixed interim prosthesis using vacuum-formed templates.

Fabrication of a custom abutment for a wide-diameter implant in a situation with limited interocclusal space

This article illustrates a technique to solve the esthetic and functional challenges of restoring implants in situations with limited interocclusal clearance. As manufactured, some wide implants lack a gold cylinder abutment that attaches directly to the implant. Instead, an intermediate abutment is provided with the system. However, with limited interocclusal space, it is not feasible to restore an intermediate abutment due to the increased restorative space required. This article describes a technique to fabricate a customized abutment that directly connects to a wide-diameter implant, resulting in a functional and esthetic restoration.