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A single implant-supported restoration is one treatment alternative to consider for the replacement of a missing tooth. Technological advances in materials and machining have led to the development of a densely sintered aluminum oxide ceramic abutment, designed and machined using CAD/CAM technology. This manufacturing method improves management of the subgingival depth of the crown/abutment interface and enhances the esthetic qualities of the restoration. However, since this ceramic abutment has less mechanical resistance than metal abutments, its use should be confined to the restoration of incisors and premolars not subjected to excessive occlusal forces.

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Endodontically treated teeth frequently require a post and core to serve as a foundation for the coronal restoration. Remaining tooth structure, physical properties of the post material, post shape, and cement type all contribute to the success of the restoration. Post adaptation to the canal walls also represents an important element in the biomechanical performance of the prosthetic restoration. A double taper post system made of quartz fiber and epoxy was developed to conform more precisely to the shape of endodontically treated canals. Immediate benefits of this post system include minimal tooth structure removal during canal reshaping, greater post-to-canal adaptation in the apical and coronal half of the canal, and good post retention. The use of a quartz fiber/epoxy material with a lower modulus of elasticity also reduces the incidence of root fracture. Furthermore, the esthetic nature of the colors offered with this post system (translucent and off-white) provide a favorable foundation for eliminating discoloration caused by a metallic post placed under all-ceramic crown systems.

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STATEMENT OF PROBLEM: From the dental professional's standpoint, implant rehabilitation offers dramatically improved treatment alternatives to orally disabled patients. However, what a patient perceives as important to their function and satisfaction with their prostheses may be quite different from what the dentist believes are significant health-related improvements. PURPOSE: To resolve this problem, a series of investigations were designed to measure satisfaction and performance in groups of patients who wore various types of prostheses supported by endosseous titanium implants. MATERIAL AND METHODS: Methods are described for assessing treatment efficacy and population needs, including measures of perceived levels of disability, health-related quality of life, and functional capacity. RESULTS: The findings highlight patient factors that have not been considered before and appear to contribute to the success of prosthetic rehabilitation for the edentulous patient. CONCLUSION: Patient-centered approaches to the assessment of treatment efficacy are highly relevant to today's prosthodontists, whose goals are the improvement of function and quality of life for their patients.

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In a within-subject cross-over clinical trial, psychometric and functional measurements were taken while 15 completely edentulous subjects wore mandibular fixed prostheses and long-bar removable implant-supported prostheses. In this paper, the results of a psychometric assessment are presented. Eight subjects first received the fixed bridge and seven the removable type. After having worn a prosthesis for a minimum of two months, subjects responded to psychometric scales that measured their perceptions of various factors associated with prostheses. They also chewed test foods while masticatory activity was recorded. The prostheses were then changed and the procedures repeated. At the end of the study, patients were asked to choose the prosthesis that they wished to keep. Patients assigned significantly higher scores, on visual analogue scales, to both types of implant-supported prostheses than to their original conventional prostheses for all factors tested, including general satisfaction. However, no statistically significant differences between the two implant-supported prostheses were detected except for the difficulty of chewing carrot, apple, and sausage. For these foods, the fixed prostheses were rated higher. Subjects' responses to category scales were consistent with their responses to the visual analogue scales. These results suggest that, although patients find the fixed bridge to be significantly better for chewing harder foods, there is no difference in their general satisfaction with the two types of prostheses.

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Although previous studies have demonstrated that implant-supported prostheses are more satisfactory and efficient for edentulous patients than are conventional prostheses, until now no investigation has directly compared different types of implant-supported prostheses. We carried out a within-subject cross-over clinical trial with fixed and long-bar removable implant-supported mandibular prostheses. Fifteen subjects were randomly divided into two groups. One group received the fixed prosthesis first, while the other first received the removable. After a two-month adaptation period, psychometric measurements of various aspects of the prostheses and physiological tests of masticatory efficiency were carried out. The prostheses were then changed, and the procedures repeated. At the end of the study, subjects chose the prosthesis they wished to keep. In this paper, we report on the data gathered at this last appointment. Eight subjects chose the fixed (F group), and seven chose the removable (R group). Both groups rated stability and ability to chew with the fixed as significantly better than with the removable. However, the R group rated ease of cleaning as the most important factor governing their decision, followed by esthetics and stability. The F group considered stability to be the most important factor in their decision, followed by chewing ability and ability to clean. There was a tendency for the removable to be chosen by older subjects (+50 years). These results suggest that patients choose fixed or removable implant-supported prostheses for specific reasons, and that patient attitudes should be considered when the design of a prosthesis is being planned for an individual patient.

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The implant-supported restoration is a relatively new and promising treatment modality. The CeraOne system offers a complete set of easy-to-use prosthetic components plus the all-ceramic and ceramometal restorative alternatives. No clinical signs of loosening have been reported since the adjunct of a torque controller that provides a tightening force of 32 Ncm to the abutment gold fixation screw. Even with these developments, however, a meticulous presurgical evaluation of the periodontium and careful fixture placement are still imperative for a successful esthetic and functional result.

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Single tooth replacement using an implant is a relatively new technique. During a study at Université de Montréal, the esthetic appearance of a single tooth restoration was directly related to the presurgical evaluation and to the implant placement. The goal of this article is to enumerate the clinical requirements and to illustrate the prosthetic results in relation to implant placement.

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For 18 years, the acid-etched bridge has been put to good use. Clinical observations over this period of time allow us to take a step back and review this conservative technique. Using the results of clinical research, this article aims to evaluate the performance and basic principles relative to the acid-etched bridge. The primary and secondary causes of debonding are also identified.

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This article is the last of a series of four. This article describes in detail the fabrication of a crown connected to a Brånemark implant.

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This article is the second of a series of four. This article describes in detail the fabrication of a complete fixed-removable prosthesis connected to a dolder bar.

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This article is the first of a series of four. Each one summarizes the clinical and technical prosthetic stages of different types of restorations. This article describes in detail the fabrication of a complete fixed prosthesis using screw type osseointegrated implants.

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