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Concept: Prosthodontics


A patient exhibited severe abrasion of resin posterior denture teeth including perforation of the denture base. New dentures were provided to explore the application of zirconia teeth for complete dentures. [Correction added to online publication 07 November 2012: “Zirconium” corrected to “Zirconia”.] Traditional denture procedures were combined with fixed prosthodontic CAD/CAM procedures to fabricate custom-designed four-tooth posterior segments in hollow crown form to reduce weight and with a retentive form for interlocking to the denture base. The new dentures were successful in reducing wear of the denture teeth over the short-term follow-up period.

Concepts: Nitrogen, Teeth, Tooth enamel, Dentures, Zirconium dioxide, Prosthodontology, Prosthodontics


This article describes a multidisciplinary approach combining surgical and prosthodontic treatment of a completely edentulous patient who presented with a severe skeletal class III relationship and was diagnosed as American College of Prosthodontists Prosthodontic Diagnostic Index (ACP PDI) class IV. The use of a complete denture serving as diagnostic tool, surgical guide, and definitive restoration is presented. Computer-aided surgical simulation was used to achieve an accurate diagnostic and surgical plan. Maxillary Lefort class I and mandibular sagittal split osteotomy surgical treatment was performed to correct arch discrepancy. The surgical procedure demonstrated a clinically acceptable maxillomandibular relationship and stability. The patient was satisfied with the esthetics and demonstrated improved oral function following prosthesis insertion.

Concepts: Diagnosis, Dentures, Class III railroad, Prosthodontics


Abstract The objective of the present study is the evaluation of the comprehensive 5-year results of fixed mandibular dentures fabricated from metal-acrylic or metal-ceramics according to the ‘All-on-4'™ protocol. Twenty-seven patients that received immediately loaded 'All-on-4'™ fixed mandibular dentures in 2005 were included in the study, and they were evaluated up to 5 years after denture integration. Endpoints were chosen in accordance with the 2007 Pisa consensus and included bone resorption, the Oral Health Impact Profile (OHIP), the Sulcus Fluid Flow Rate (SFFR), and prosthodontic complications. The initial situation in both groups was largely identical. Bone loss remained under 2 mm after 5 years in all implants and showed no group difference. The SSFR showed a gradual increase in both groups, and acrylic-bearing implants showed a substantially and significantly higher flow rate from the third year onward. The subjective improvement as expressed by the OHIP score was immediate and dramatic, and it showed no group differences. All acrylic restorations showed some extent of abrasion, and veneer fractures occurred in 4 patients (28.6%). Besides a single fracture of a fixation screw, there were no prosthetic complications in patients with ceramic suprastructures. According to bone loss and subjective outcome, acrylic and ceramic suprastructures apperared to be equivalent after 5 years; however, sulcus flow and prosthodontic complications suggest that the economic advantage of acrylic dentures may be specious. The rational choice of implant suprastructures requires comprehensive, long-term observation. Short-term economical benefits might be cancelled out in the long run.

Concepts: Time, Bone, Bone fracture, Fracture, Fluid dynamics, Economics, Dentures, Prosthodontics


The aim of this study was to investigate whether advanced simulation parameters, such as simulation exam scores, number of student self-evaluations, time to complete the simulation, and time to complete self-evaluations, served as predictors of dental students' preclinical performance. Students from three consecutive classes (n=282) at one U.S. dental school completed advanced simulation training and exams within the first four months of their dental curriculum. The students then completed conventional preclinical instruction and exams in operative dentistry (OD) and fixed prosthodontics (FP) courses, taken during the first and second years of dental school, respectively. Two advanced simulation exam scores (ASES1 and ASES2) were tested as predictors of performance in the two preclinical courses based on final course grades. ASES1 and ASES2 were found to be predictors of OD and FP preclinical course grades. Other advanced simulation parameters were not significantly related to grades in the preclinical courses. These results highlight the value of an early psychomotor skills assessment in dentistry. Advanced simulation scores may allow early intervention in students' learning process and assist in efficient allocation of resources such as faculty coverage and tutor assignment.

Concepts: Completeness, Education, Skill, Learning, Resource allocation, Final examination, Prosthodontics, Fixed prosthodontics


Repeated fracture of the denture base is a common problem in prosthodontics, and it represents a nuisance and a time sink for the clinician. Therefore, the possibility of increasing repair strength using new reinforcement materials is of great interest to prosthodontists.

Concepts: Materials science, Dentures, Prosthodontics, Methyl methacrylate


Dental rehabilitation of acute cases of enamel renal syndrome is challenging due to the absence of clinical reports. In the present case history report, examination of an 18-year-old patient revealed a complete lack of permanent teeth, as well as irregular and swollen bone and gingival morphology. Radiographs showed multiple impacted teeth in both arches. Creating a 1.5- to 2-cm interarch space was necessary for setting complete dentures. The ideal occlusal plane was chosen by combining two techniques (cephalometric radiograph and modification of the mandibular occlusal rim according to anatomical guidelines). Extraction of impacted teeth and recontouring of the alveolar process were performed simultaneously. The mandibular denture was connected through Locator abutments to two symphyseal implants. This pioneering clinical report will provide guidance to practitioners in the surgical intervention of patients with FAM20A (family with sequence similarities 20 A) gene mutations.

Concepts: Physician, Teeth, Prosthesis, Oral hygiene, Dentures, Removable partial denture, Prosthodontics, Denturist


The aim of this study was to investigate whether prosthodontic residents' attitudes toward provider-client communication would be shaped by a tailor-made communications skills course. In 2016, the pre-intervention attitudes of all six second- and third-year prosthodontic residents in a three-year residency at an academic dental institution in India were assessed using the Communication Skills Attitude Scale (CSAS). The residents' performance was then video-recorded while they treated complete denture patients and was analyzed using the Kalamazoo scale, a validated scale for communication skills assessment. The residents' weaknesses were identified, and a custom-made generic module was designed along with individual guidance counseling for addressing aspects relevant to complete denture patients. The residents' attitudes were again assessed immediately after they completed the training using CSAS, as well as after two and four months using Balint sessions. Analysis of the recordings showed that few of the deficiencies during intraoral procedures were contextual, and the Kalamazoo scale did not address them: these were noted as being “beyond Kalamazoo.” After the training, the residents reported awareness of their weaknesses and feeling motivated to practice their newly acquired skills. The Balint sessions showed that they had started valuing patients' agendas and the rapport-building process, and they reported transfer of skills when treating other types of prosthodontic patients. In this study, a customized communication skills module brought about a positive change in residents' attitudes, which was sustained over four months. Similar training could be implemented in other dental specialties.

Concepts: Completeness, Communication, Dentures, Message, The Residents, Prosthodontics, Visual communication, Graphic communication


The purpose of the systematic review and meta-analysis was to compare the performance of three-unit bridges on teeth with three-unit bridges on implants, evaluating survival of the bridges, survival of the teeth or implants, condition of the hard and soft tissues surrounding the supports, complications and patient-reported outcome measures after a mean observation period of at least 1 year. A literature search was conducted using a combination of the search terms: fixed partial denture and fixed dental prostheses. An electronic search for data published until January 2017 was undertaken using the Medline, Embase and Cochrane Library databases. Eligibility criteria included clinical human studies, either randomized or not, interventional or observational, which evaluated the results of three-unit FDPs (fixed dental prostheses) on either two implants or two abutment teeth. The search identified 1686 unique references. After applying eligibility criteria 66 articles were included in the analysis. A total of 1973 three-unit FDPs were supported by teeth, and 765 were implant-supported. No significant differences were found either in the survival of the supporting abutments (P=0.52; 99% versus 98.7% survival per year) or in the survival of the prostheses (P=0.34; 96.4% versus 97.4% survival per year). Both treatments show an almost equally low complication rate, but there is a low level of reporting of hard and soft tissue conditions and patient-reported outcome measures. It is concluded that implant-supported three-unit FDPs seem to be a reliable treatment with survival rates not significantly different from the results of teeth-supported three-unit FDPs. This article is protected by copyright. All rights reserved.

Concepts: Evidence-based medicine, Tissues, Soft tissue, Teeth, All rights reserved, Copyright, Bridge, Prosthodontics


The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics in a complete virtual environment without any physical model situations. The aim was to compare fully digitalized workflows to conventional and/or mixed analog-digital workflows for the treatment with tooth-borne or implant-supported fixed reconstructions.

Concepts: Virtual reality, Business process modeling, Prosthodontics, Fixed prosthodontics


Peri-implantitis has been described as progressive crestal bone loss around a dental implant. The condition is poorly understood, and is challenging to manage; it is commonly and widely attributed to issues with the implant, the implant surface, surgical technique and oral hygiene. The effect of prosthodontic stages of treatment on the postoperatively established state has not been adequately investigated. It is the authors' contention that the manner in which the implant is restored contributes significantly to prognosis and peri-implant disease experience, and that the role of prosthodontic aspects of treatment in the causation of peri-implantitis may be seriously underestimated. The prosthodontist has a clear role and responsibility in the avoidance of future peri-implant problems by ensuring that implants are restored in an entirely biologically and biomechanically sound manner. The number of implant treatments carried out year-on-year is rising apace, with more and more implants being restored in general dental practice. With the rapid emergence of lower cost dental implant systems and a broadening range of generic restorative options and components for well-established systems, there is an increasing need to consider and understand how the implant restorative process may have a negative impact upon the peri-implant tissues, and how this effect may be minimised and peri-implant health promoted and maintained by paying attention to detail throughout the entire process.

Concepts: Surgery, Implants, Dental implant, Dentistry, Oral and maxillofacial surgery, Dentures, American Dental Association, Prosthodontics