Hybrid abutments consist of a titanium insert, which is connected to a ceramic mesostructure using a resin cement
These types of abutments have the advantages of both ceramic and titanium abutments, including improved esthetics, optimal biological response, and superior mechanical properties, with no adverse effects on the implant–abutment interface.
Esthetic considerations in implant placement Esthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placement
This seminar deals with implant-related complications that lead to implant failure.this also discus diagnostic criteria and preventive methods for an implant failure.
differences between natural tooth periodontium and implant bone connection, biomechanics of implants, implant protected occlusion , occlusal principles for single tooth implant prosthetics and implant supported prosthesis on edentulous arch, shortened arch concept, therapeutic occlusion
Esthetic considerations in implant placement Esthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placementEsthetic considerations in implant placement
This seminar deals with implant-related complications that lead to implant failure.this also discus diagnostic criteria and preventive methods for an implant failure.
differences between natural tooth periodontium and implant bone connection, biomechanics of implants, implant protected occlusion , occlusal principles for single tooth implant prosthetics and implant supported prosthesis on edentulous arch, shortened arch concept, therapeutic occlusion
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
The benefits of implant dentistry can be realized only when the prosthesis is first discussed and determined. An organized treatment approach based on the prosthesis permits predictable therapy results. Five prosthetic options postulated by Misch are available in implant dentistry. Three restorations are fixed and vary in the amount of hard and soft tissue replaced; two are removable and are based on the amount and type of support for the restoration. The amount of support required for an implant prosthesis should initially be designed similar to traditional tooth-supported restorations. Once the intended prosthesis is designed, the implants and treatment surrounding this specific
result can be established.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
The benefits of implant dentistry can be realized only when the prosthesis is first discussed and determined. An organized treatment approach based on the prosthesis permits predictable therapy results. Five prosthetic options postulated by Misch are available in implant dentistry. Three restorations are fixed and vary in the amount of hard and soft tissue replaced; two are removable and are based on the amount and type of support for the restoration. The amount of support required for an implant prosthesis should initially be designed similar to traditional tooth-supported restorations. Once the intended prosthesis is designed, the implants and treatment surrounding this specific
result can be established.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
History of biomaterials in dental implantology, various types of implant biomaterials, surface treatments of implants, guidelines for selecting implant biomaterial
Arch wire4 /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Titanium and its alloy /certified fixed orthodontic courses by Indian dent...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
Implants in orthodontics / /certified fixed orthodontic courses by Indian den...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Split ridge and expansion techniques are effective for the correction of moderately resorbed edentulous ridges in selected cases.
Transverse expansion is based on osseous plasticity obtained by corticotomy. It progressively allows for an adequate transversal intercortical diameter large enough to insert one or several dental implants.
The gap created by sagittal osteotomy expansion undergoes spontaneous ossification, following a mechanism similar to that occurring in fractures.
The maxillary sinuses were first illustrated and described by Leonardo Da Vinci in 1489 and later documented by the English anatomist Nathaniel Highmore in 1651.
The maxillary sinus, or antrum of Highmore, lies within the body of the maxillary bone and is the largest and first to develop of the paranasal sinuses.
Shape- a pyramid-shaped cavity; base- adjacent to the nasal wall; apex- pointing to zygoma.
Size- insignificant until eruption of permanent dentition; average dimensions of adult sinus- 2.5–3.5 cm wide, 3.6–4.5 cm tall, and 3.8–4.5 cm deep; estimated volume of approximately 12–15 cm.
Extent- Anteriorly, extends to canine and premolar area. sinus floor usually has its most inferior point near the first molar region.
Reconstruction of a facial defect is a complex modality either surgically or prosthetically, depending on the site, size, etiology, severity, age, and the patient’s expectation. The loss of an auricle, in the presence of an auditory canal, affects hearing, because the auricle gathers sound and directs it into the canal.
Surgical reconstruction is preferable but prosthetic approach may be necessary in some circumstances such as the presence of complex or large defects, requirement of the recurrence control, local or general contraindications of surgery, damaged neighboring tissues due to the radiotherapy, general poor health, failed reconstructive attempts previously made, refusal of the surgery by the patient, high esthetic demands, the desire for a quick recovery and palliatively operated patients.
Nowadays, craniofacial implants are used to support and retain such prostheses. Studies have shown successful retention and stability of auricular prostheses anchored to the temporal bone with titanium implants.
The main concept of osseodensification technique is that the drill designing creates an environment which enhances the initial primary stability through densification of the osteotomy site walls by means of autografting of bone.
Digital Removable Complete Denture—an Overview.pptxNishu Priya
There is a great responsibility for a dentist and a dental technologist to fabricate high-quality removable complete
dentures. Factors, such as a meticulous diagnosis and treatment planning, a personal communication between the
involved persons, and a profound knowledge of the clinical and technical possibilities, should lead to an easy, simple,
cost-effective, and highly satisfying denture fabrication workflow.
The Tall Tilted Pin Hole Placement Immediate Loading.pptxNishu Priya
The Tall Tilted Pin Hole Immediate Loading (TTPHIL) concept has evolved from various ideologies in implantology: basal, pterygoid, and angulated/tilted implants under immediate loading.
To maximize the success of rehabilitation, the TTPHIL technique utilizes the use of long tilted bicortical implants. Longer implants have more bone to implant contact, thus, improving osseointegration.
By engaging the alveolar and nasal cortex, hard tissue augmentation procedures and vital structures in the premaxilla are avoided.
In the posterior maxilla, pterygoid implants are placed.
smile designing. The terms ‘aesthetic zone’ and ‘smile zone’ are commonly used to denote the appearance
of the teeth and smile. This zone has been shown to influence significantly factors
such as social acceptability, self-confidence and professional prospects. It is paramount
to undertake a meticulous assessment of the aesthetic zone during patient examination,
so that you may best determine which features may require addressing while developing
the treatment plan.
Management of tmd symptoms with photobiomodulation therapyNishu Priya
Conservative approaches, such as soft diets, anti-inflammatory drugs and photobiomodulation therapy (PBMT) or low-level laser therapy (LLLT), have been used to manage TMD.
Lasers have proven to be successful in clinical settings and treatments of soft tissues, musculoskeletal pain, bone regeneration, dentinal hypersensitivity, and provide reduction in symptoms and improved function.
The mechanism of action in PBMT is via absorption of light, with deeply penetrating wavelengths ranging from 630 nm to 1300 nm, to stimulate tissues with direct irradiation to achieve analgesic and anti-inflammatory effects.
The output energy in PBMT does not affect skin temperature and is classified as a soft laser, which increases lymphatic flow, reduces edema and prostaglandin E2 (PGE2) and cyclooxygenase (COX) levels.
A systematic review for pain management reported placebo vs LLLT for practical and clinically relevant parameters using 700nm to 1200nm.
Prosthodontic rehabilitation of maxillary defect in a patientNishu Priya
Restoration of maxillectomy defects demand varied modifications in prosthesis fabrication, to make them lighter and well-tolerated by the patient.
Literature suggests the use of various retentive aids for the construction of conventional obturator to improve retention and oral function.
Fabrication of functional complete dentures for edentulous patients who have undergone hemimandibulectomy is a very arduous and demanding endeavor.
The most challenging situation encountered during this procedure is the deviation of the mandible to the resected side. The deviation of the mandible to the resected side is directly proportional to the loss of tissues in the area hemi-mandibulectomy has been performed.
In cases with Cantor and Curtis classes II, III, IV, and V, guide flange prosthesis would be a treatment modality. For guide flange prosthesis to be effective, the sufficient number of posterior teeth that are periodontally sound should be present in the opposite arch.
In patients where reconstruction is not done after resection of the mandible, scar tissue formation occurs over a period of time that stiffens the tissues and worsens prosthetic rehabilitation, leading to compromised treatment planning.
A successful prosthesis comprises an aesthetic restoration, having good functional qualities allowing comfortable and confident use. Absolute success however can only be considered if the histological and morphological normality of the mucosa and deep supporting tissues is maintained.
It is critical to understand the mucosal response to prosthodontic prostheses for the treatment outcome.
The anatomy of the edentulous ridge in the maxilla and mandible is very important for the design of a complete denture. Objective in fabrication of a complete denture is to provide a prosthesis that restores lost teeth and associated structures functionally, anatomically and aesthetically as much as possible with preservation of underlying structures and the knowledge landmarks help us in achieving our objective.
Sterilization and disinfection in prosthodonticsNishu Priya
Routinely dental care professionals are at an increased risk of crossinfection while treating patients. This occupational potential for disease transmission becomes evident initially when one realizes that most human microbial pathogens have been isolated from oral secretions. Because of repeated exposure to the microorganisms present in blood and saliva, the incidence of certain infectious diseases has been significantly higher among dental professionals than observed for the general population.
Introduction
CERAMICS : An inorganic compound with non-metallic prosthesis typically consisting of oxygen and one or more metallic or semi-metallic elements that is formulated to produce the whole part of a ceramic based dental prosthesis. – GPT 7.
The word Ceramic is derived from the Greek word “keramos”, which literally means ‘burnt stuff’, but which has come to mean more specifically a material produced by burning or firing.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Introduction
• Titanium implant abutments are widely used due to their optimal physical and mechanical
properties, including high strength and biocompatibility.
• However, these abutments compromise the esthetic appearance of the final restoration due to their
gray color, especially in patients with thin mucosa.
• Over time, the development of ceramics and computer-aided design and computer-aided
manufacturing (CAD/CAM) systems, along with an increasing esthetic demand of patients, led to the
fabrication of all-ceramic abutments that improved the esthetic outcome of treatments.
• High-strength ceramics, including zirconia, are now an optimal option for the fabrication of implant
abutments.
3. One-piece zirconia abutments have several shortcomings.
Evidence shows titanium abutments have a significantly better fit than zirconia abutments as
ceramics cannot be machined as accurately as metals.
High rate of fracture is another drawback of one-part zirconia abutments, which either occurs at the
implant–abutment connection or in the transmucosal part of the abutment.
One-piece zirconia abutments
4. In contrast, significant differences in the physical properties of zirconia and titanium,
especially, in terms of hardness and modulus of elasticity, can cause wear and damage
to the internal components of the implant fixture.
5. • Due to the aforementioned limitations, the idea of
hybrid abutments was suggested.
• Hybrid abutments consist of a titanium insert,
which is connected to a ceramic mesostructure
using a resin cement
• These types of abutments have the advantages
of both ceramic and titanium abutments,
including improved esthetics, optimal
biological response, and superior mechanical
properties, with no adverse effects on the
implant–abutment interface.
Two-piece zirconia abutment
6. Pre-crystallized lithium
disilicate
• Introduction of pre-crystallized lithium disilicate blocks (IPS-Emax
CAD), which have a perforation that provides an intimate fit with the
titanium insert, enabled the fabrication of monolithic implant-
supported restorations even with the chair-side CAD/CAM systems.
• The monolithic nature of restorations prevents some complications
such as ceramic fracture and chipping.
• Lithium disilicate abutments can be used in the form of hybrid
abutment with a separate crown or hybrid abutment-crown with the
abutment and crown fabricated as one piece, which will then be
bonded to the titanium insert.
7. Hybrid ceramic
blocks
• Polymer-infiltrated ceramic network material is a new category of
materials with an interconnected dual network structure of ceramic
and polymer (VITA ENAMIC, Vita Zahnfabrik).
• This group of materials has the advantages of both ceramics
(optimal durability and color stability) and composite resins
(improved flexural properties and low abrasiveness).
• Enamic by VITA is among these materials, which is composed of
a pre-sintered feldspathic ceramic reinforced by a polymer
network.
• The Enamic-perforated blocks used for the fabrication of
monolithic screw-retained implant-supported restorations have an
integrated connection, which is compatible with the titanium
bases.
• Restorations fabricated using these materials do not require
8. CAD CAM Polymethyl methacrylate blocks
• Polymethyl methacrylate blocks (Telio CAD and VITA CAD temp)
are indicated for implant-supported, long-term provisional single
restorations for the purpose of soft tissue management.
• These blocks are available with a connection geometry for
attachment to a titanium insert.
9. Digital vs Conventional workflow
• Hybrid abutments may be produced in a digital or conventional workflow.
• In the conventional method, the abutment crown is formed over the prefabricated titanium base
with wax that will be transferred to lithium disilicate through the pressing technique (IPS e.max
Press).
• The restoration should be tried in the oral cavity prior to bonding the hybrid abutment/crown to
the titanium base due to the required correction.
• In the digital technique, a digital impression is made either from the oral cavity by a scan
body/scan post or from the cast.
• The proper titanium insert is selected according to the implant system and then CAD/CAM
software is intended to design and fabricate the abutment or abutment/crown.
10. Effect of peri-implant soft tissue and bone
• The mucosal attachment formed around titanium or ceramic
abutments is composed of two parts: junctional epithelium and
connective tissue.
• Mehl et al assessed the effect of hybrid abutments made of zirconia
or lithium disilicate bonded to a titanium base by resin cement on
peri-implant tissues. They revealed that the abutment material and
the use of two-piece abutments with adhesive resin joint had no
significant effect on bone loss and soft tissue anatomy except that the
height of junctional epithelium was longer around one-piece titanium
abutments compared with two-piece zirconia abutments.
• Mehl et al, in another study, demonstrated that two-piece implant
abutments with a machined surface led to better adhesion of host
cells than abutments with a polished or rough surface.
• Both studies confirmed the biocompatibility of zirconia and lithium
11. Mechanical properties
• A recent systematic review showed that titanium inserts bonded to zirconia increased the overall
fracture resistance, prevented the implant connection wear, and resulted in better marginal fit
compared with one-piece zirconia abutments.
• Elsayed et al concluded that hybrid ceramic abutment made of zirconia and lithium disilicate can
tolerate heavier loads compared with the physiologic loads applied to the anterior region (150–235 N).
• Therefore, they are suitable treatment options for single implant rehabilitation in the anterior region.
• Nouh et al demonstrated that zirconia hybrid abutment fracture resistance was significantly higher
than that of lithium disilicate.
• Therefore, these restorations can be successfully used in the clinical setting for rehabilitation of the
premolar region.
12. Mode of failure
• Application of a fragile material on natural teeth is not problematic due to the presence of periodontal
ligament, while the same material may cause a range of mechanical complications, including fracture
and chipping when applied as implant restorations.
• Nouh et al, observed failure in both titanium base (bending and fracture) and ceramic supra-structure
(fracture and adhesive failure).
• Elsayed et al reported that the most common failure mode in one-piece zirconia abutments was a
fracture at the abutment-implant connection slightly higher than the implant shoulder, while permanent
plastic deformation of the abutment screw and internal connection of titanium base or distortion of the
labial platform of the implant was observed, with no fracture in the ceramic, in zirconia and lithium
disilicate hybrid abutments with a titanium base.
• In addition, Rosentritt et al. reported the bending and fracture of abutment screws as the most common
failure modes of hybrid abutments.
13. A 57-year-old woman presented with a chief complaint of being unhappy with how her front
teeth looked when she smiled .
14. Clinical examination revealed endodontic treatment in tooth 8, and the root canal was obturated with
gutta-percha. Periapical radiographs revealed that tooth 8 had a fiber post, and teeth 7, 9, and 10 had
defective proximal composite resin restorations. The insufficient tooth structure indicated the need for
full-coverage crowns.
15. Tooth 8 had recurrent decay 2–3 mm beyond the cemento-enamel junction and was considered
non-restorable. Treatment options other than an implant included crown lengthening; this was not an
optimum option, as it would require excessive bone removal for a greater biological width. Consequently,
tooth 8 would not appear esthetic, being 2–3 mm longer than the adjacent tooth. Orthodontic extrusion
would result in a cervical neck narrower than that of tooth 9, resulting in a large black triangle. Therefore,
we opted for tooth extraction and immediate implant placement. A traumatic extraction was performed for
tooth 8 under local anesthesia.
An implant (Nobel
Speedy Replace, Nobel
BioCare, Zürich,
Switzerland) with a
4.3-mm diameter and
13-mm length was
placed in the extraction
socket; thereafter, a 4.3
× 3-mm Ti -based
healing abutment was
placed
16. Follow-up appointments at
1 week [Figure 3c] and 2
months [Figure 3d] showed
that the soft tissue responded
favorably, and bone
augmentation was left to heal
for 4 months.
Provisional crowns were
splinted and fabricated
from bis-acryl as a 4-unit
provisional fixed dental
prosthesis (FDP) [Figure
4a-c] modified per the
patient’s
Request.
17. An NB-RS 4.3-L Ti-base (Dentsply Sirona
Ti-base; InLab, Bensheim, Germany) was
scanned using Cerec AC Connect with
Omnicam (Dentsply Sirona, York, PA,
USA).
The customized zirconium oxide abutment
was designed using a digital software (inLab
SW4.2, Dentsply Sirona, York, PA, USA).
The zirconia abutment was milled from
a pre-sintered meso Zr shade F0.5 block
(InCoris TZI, Sirona GmbH, Germany) using
a milling production unit.
The Ti-base outer surface
and Zr-abutment intaglio
were sandblasted with
50-μm aluminum oxide.
RelyX Ultimate was used
to connect the Ti-base
with the Zr-abutment and
tried-in as one piece
18. Definitive crowns for the implant abutment and prepared teeth were fabricated from
low-translucency IPS e.max Press LD.
19. Discussion
• Clinicians strive to improve implant crowns and their biomechanical and esthetic
characteristics.
• Screw-retained implants possess retrievability and are usually the first option to eliminate
excess cement from extruding on the platform, especially for deeply placed implants.
• In this case, it was evident with the provisional crown that the screw-access channel was
from the incisal edge, and covering the definitive crown screw-access channel with
composite on the incisal surface would not be esthetically acceptable.
• Accordingly, a cement-retained crown design was chosen for our implant; retrievability might
not be a feature in cement-retained crowns, but they respond to functional loads differently.
Thus, abutment-screw loosing is not a major concern.
20. • The Procera copy milling system produces a Ti abutment without needing the casting step, as
it does not rely on wax bur-out. This reduces the abutment fabrication time, but the metallic
color remains.
• The implant was placed 4–5 mm apical to the adjacent cemento-enamel junction so that the
apical portion engaged the more native bone.
• If an LD crown was directly cemented on a Ti abutment intraorally, there would be flow of
excess cement material and its extrusion close to the implant platform. Furthermore, the LD
would be in direct contact at the 4–5-mm soft tissue area; no data currently shows how the
LD surfaces interact with soft tissue in direct contact.
• A clinical study found no distinct differences in the health of peri-implant mucosa adjacent to
zirconia and Ti abutment surfaces, with both showing favorable responses.
21. • From an economic point of view, the cost was reduced by half.
• A limitation of this technique is that it requires an additional clinical and laboratory
step when compared with Ti-based monolithic restorations.
• A hybrid-abutment try-in appointment is required to evaluate the zirconia
abutment finish line before proceeding with the definitive restoration; the LD
implant crown was inserted at a later appointment.
22. Conclusion
The technique presented here eliminated the need for
the casting step and of a high-noble metal
substructure, thus reducing the estimated cost by half.
It also allowed the definitive implant and
teeth-supported LD crowns to blend in with the
adjacent and opposing teeth. Follow-up demonstrated
how the soft tissue surrounding the implant and teeth
had a positive response. Longer follow-ups remain to
be conducted to monitor bone levels upon crown
insertion. Nonetheless, clinicians may use this
alternative approach to fabricate single implant
crowns, as they provide optimum esthetics and
biomechanics in the anterior maxillary region.
23. A 40-year-old male patient was referred to the dental office with a complaint of smile dissatisfaction
relating to the appearance of their maxillary incisors associated with pain during chewing.
Initial case showing extensive restoration in the anterior teeth and color mismatch of the incisors.
The clinical examination revealed extensive direct restorations in the anterior teeth with
unsatisfactory
color and unusual movement of the crown.
24.
25.
26. A–F) Implant placement procedure and temporary abutment preparation. (A) Frontal view of the alveolus. (B) Implant installation. (C, D) Abutment installation.
(E) Implant temporary framework installation and (F) adaptation.
27. Temporary crown individualization. (A) ATeflon tape was used to protect the screw access hole. (B, C) Insertion of acrylic resin at the abutment’s anterior
face, and, the positioning of the individualized veneer. (D) Removal of the unfinished temporary crown. (E, F) The crown in position immediately and after the healing
period.
28.
29. A metallic link was used for the connection between the zirconia mesostructure and
the abutment
30.
31.
32. (A–F) Ceramic veneering adhesive cementation. (A) Tooth prepared to receive a veneer and the implant protection with an individualized transfer. (B) Tooth
substrate acid etching. (C) Adhesive system application. (D) Resin cement application on the ceramic veneer intagliosurface. (E) Excess cement removal with a microbrush.
(F) Light activation.
33.
34. Discussion
Dental implant rehabilitation can be defined as successful when the natural contours of the lost
element are recovered in the prosthesis, achieving harmony with the adjacent teeth.
The final result of the presented clinical case demonstrated the importance of an atraumatic extraction
to preserve the supporting bone tissue and to maintain a large and natural-looking for peri-implant soft
tissue.
Immediate loading by the installation of a well-defined temporary crown with a concave and well
polished emergence profile ensures better tissue resilience after surgery, with almost no unwanted
remodeling, which in turn facilitates the prognosis of the case.
However, it is important that this emergence profile achieved with the temporary crown during healing
is also transferred to the model for manufacturing the final restoration, thereby enabling anatomic
similarity of both temporary and final crowns.
35. The zirconia mesostructure metal link is used to ensure a hybrid abutment with a large amount of
polycrystalline material which diminished the grayish effect on the mucosa;however, it also ensures
the metallic connection between the abutment and crown at the same time, which reduces the
incidence of mechanical problems in this interface.
For this case, the veneering manufacture on the adjacent tooth made in the same material as the
implant-supported crown helped to achieve a final harmonic smile.
However, this restorative modality should only be performed when the healthy tooth has the
indication for it, as in this case.
As a study`s limitations the radiographs are not available.
36. Conclusion
• In esthetically challenging treatments, ceramic abutments provide more natural outcomes
than traditional titanium abutments.
• In two-piece ceramic abutments, the presence of titanium inserts can overcome the
brittleness of ceramic, improve fracture resistance, and prevent wear and damage to the
internal connection of the implant fixture.
• In contrast, the monolithic nature of these restorations prevents some mechanical
complications including ceramic chipping.
• Furthermore, extraoral cementation reduces the possibility of peri-implantitis.
• Although hybrid abutments are recommended by in vitro studies as a promising treatment
option, there is a strong need for long-term clinical studies to evaluate the clinical
performance of these abutments. Therefore, this type of abutment should be used bearing
the current limitations in mind.
37. Reference
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