QDT 2025: Mastering Interdisciplinary Treatment E-Book

Vincent Fehmer

• Herausgeber: Quintessence Publishing Co, Inc
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 80

Veröffentlichungsjahr: 2025

Beschreibung

QDT has always served dental technicians with the best of the best work being done in the field. But technical artistry is only half of the equation, which is why QDT 2025 focuses on the whole picture of interdisciplinary dentistry, highlighting how clinician and technician work together to achieve predictable and esthetic outcomes. This year's issue is stacked with several articles on FP1 prostheses and the digital workflows and procedures required for their planning and delivery, as well as multiple articles on minimally invasive laminate veneers and other topics relevant to daily practice, such as the fabrication of digital complete dentures, shade matching zirconia crowns, and managing the single central incisor. Throughout the issue, the latest technologies and their capabilities are emphasized, truly reflecting this era of digital dentistry while always relying on the foundation of manual skills and artistry, which can never fully be replaced by digital tools. With such a stellar group of contributing authors, this may just be the best issue of QDT yet.

Leseprobe

One book, one tree: In support of reforestation worldwide and to address the climate crisis, for every book sold Quintessence Publishing will plant a tree (https://onetreeplanted.org/).

Library of Congress Control Number: 2024947471

A CIP record for this book is available from the British Library.

ISSN: 1060-1341 / ISBN: 978-1-64724-230-5

PUBLISHER

Christian W. Haase

PUBLISHER EMERITUS

H. W. Haase

EDITORIAL DIRECTOR

Leah Huffman

DESIGN/PRODUCTION

Angelina Schmelter

MANUSCRIPT SUBMISSION

QDT publishes original articles covering dental laboratory techniques and methods. For QDT submission information, contact the publisher ([email protected]).

Copyright © 2025 by Quintessence Publishing Co, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information and retrieval system, without permission in writing from the publisher. The publisher assumes no responsibility for unsolicited manuscripts. All opinions are those of the authors.

Permission to photocopy items solely for internal or personal use and for the internal or personal use of specific clients is granted by Quintessence Publishing Co, Inc, for libraries and other users registered with the Copyright Clearance Center (CCC) provided the appropriate fee is paid directly to CCC (www.copyright.com).

© 2025 Quintessence Publishing Co, Inc

Quintessence Publishing Co, Inc 411 N Raddant Road Batavia, IL 60510www.quintessence-publishing.com

5   4   3   2   1

ISSN: 1060-1341

Cover and title page photos courtesy of Taban Milani, dds, winner of our QDT 2025 cover contest.

2025

Editorial: Embracing Innovation for the Future of Dental Carevi

Vincent Fehmer

Segmented Monolithic Zirconia Titanium-Supported Double 2 Full-Arch FP1 Prostheses: A Novel Approach

Stavros Pelekanos, Emil Bobev, Vassiliki Rizou, Tanya Spyropoulou, and Panagiotis Ntovas

Treating Terminal Dentition with FP1 Prostheses: 23A Digital Perioprosthodontic Approach

Ramon Gomez Meda and Jonathan Esquivel

Full-Arch Implants: FP1—A Digital Reinterpretation40

Venceslav Stankov, Florin Cofar, David Norré, Adrian Argint, Alexander De Greef, Ioana Popp, Alexander Nikolov, Wael Att, and Eric Van Dooren

Achieving the FP1 Restoration via Prosthetically Guided 68 Tissue Sculpting

Naif Sinada and Christina I. Wang

Reference Denture Technique: A Paradigm Shift86in Contemporary Prosthodontic Rehabilitation

Eric D. Kukucka and Nelson R.F.A. Silva

Predictable Digital Workflows in Reconstructive Dentistry 113

Juan Legaz

Porcelain Laminate Veneers in 2025: Combining Technology130with Evidence-Based Clinical and Laboratory Workflows

Julian Conejo, Sergio Losas, Telmo Santos, and Markus B. Blatz

Ultrathin Ceramic Veneers to Restore Adjacent Teeth 146 and Implants

Oscar Gonzalez-Martin, Javier Pérez, and Gustavo Avila-Ortiz

QUINTESSENCE OF DENTAL TECHNOLOGY

Volume 47

Laminate Veneers: Preserving the Essence of Natural Teeth160

Naoki Hayashi

Noninvasive and Straightforward Treatment of Localized 170 Tooth Wear with Hybrid Ceramic (PICN):The Orthodontic-Assisted One-Step No-Prep Technique

Amélie Mainjot

Contrast and Filter Techniques in Ceramic Layering for 186 Natural-Looking Anterior Crowns

Hans Joit

Anterior Cantilever Bridge with Zirconia Infrastructure 202 Coupled with a Pressed Glass-Ceramic Coating:Clinical and Laboratory Implementation

Romain Ceinos, Jean Richelme, Flore Moradei, and Fabio Levratto

Shade-Matching Technique for Full-Contour Zirconia Crowns 217

Hiro Tokutomi, Kimiyo Sawyer, Julian Conejo, and Markus B. Blatz

Low-Viscosity Resin Infiltration for Enamel White Spots 230

Meiken Hayashi

A Digital Leap in Ortho-Restorative Dentistry: 244Case Report on a Unified Approach to Minimally Invasive Restorations and Orthodontic Treatment

Andrea Patrizi and Alexis Ioannidis

How to Manage the Single Central Incisor 259

Yuki Momma

Editorial:

Embracing Innovation for the Future of Dental Care

As we navigate an era defined by rapid technologic advancements, the dental community stands at a transformative moment. With the Quintessence of Dental Technology (QDT), our mission has always been to bridge the gap between innovative practices and real‑world ap- plications in dentistry. In this edition, we reflect on the transformative power of technology in our field and the profound implications for patient care, education, and professional growth.

The last few years have seen remarkable progress in dental technology, from the integra- tion of digital dentistry to the rise of telehealth solutions. These advancements not only en-

vi

hance our diagnostic and treatment capabilities but also elevate the patient experience, making care more efficient and accessible. As we embrace these tools, we must also recog- nize the responsibility that comes with them. Continuous education and adaptation are es- sential, ensuring that we leverage these technologies effectively and ethically.

Collaboration within our community has never been more crucial. The sharing of knowl- edge and experiences among dental professionals encourages an environment of growth and innovation. Through our publications, we aim to create a platform where ideas can flour- ish and where practitioners can stay informed about the latest research, techniques, and ma- terials. Your contributions are invaluable in this ongoing dialogue, and we encourage you to share your insights and experiences with us.

Moreover, as we look ahead, it’s vital to consider the holistic impact of our technologic advance- ments. How do they influence patient outcomes, and how can we use these tools to promote preven- tive care? The future of dentistry is not just about adopting new technologies; it’s about enhancing the relationship between patient and provider.

As we present the latest research and insights in this issue, I invite you to reflect on how you can integrate these advancements into your practice. Let us embrace the challenges and op- portunities that lie ahead with open minds and a commitment to excellence.

Thank you for your continued support of QDT. Together we can shape the future of dental technology and ultimately improve the lives of our patients.

Warm regards,

Image courtesy of Luis Quintero, CDT, runner-up in our QDT 2025 cover contest.

Segmented Monolithic Zirconia Titanium- Supported Double Full-Arch FP1 Prostheses:

A Novel Approach

Stavros Pelekanos, DDS, Dr Med Dent1

Emil Bobev2

Vassiliki Rizou, CDT1

Tanya Spyropoulou, CDT1

Panagiotis Ntovas, DDS, MSc3

Today implant‑supported full‑arch rehabili- tations are a common treatment option for patients with edentulism or failing dentition.1 This article describes material selection and the use of digital technology for the rehabilitation of a patient with terminal dentition compromised by dental caries and periodontal disease.

1Private practice, Athens, Greece.

2Guided surgery specialist, Berlin, Germany.

3Scientific affiliate, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.

Correspondence to: Panagiotis Ntovas, [email protected]

QDT 2025 | Volume 47

3

Pelekanos et al

Patient Presentation

A 59‑year‑old man presented to the clinic with the chief complaints of an unsatisfactory smile appear- ance, limited masticatory function, halitosis, and pain while chewing (Figs 1 to 3). The patient was in good general health with a noncontributory medical history except for smoking five cigarettes per day. Clinical and radiographic examination (Figs 4 and 5) revealed ram- pant caries, nonrestorable teeth, soft tissue inflamma- tion, tooth mobility, residual roots, and missing teeth. The patient was diagnosed with generalized peri- odontitis (Stage IV, Grade B).2

Etiology and Diagnosis

Terminal dentition refers to dentition that is compro- mised to the extent that either the teeth cannot be re- stored or they present with inadequate periodontal

FIGS 1 TO 3 Preoperative clinical views of the patient smiling.

QDT 2025 | Volume 47

4

Pelekanos et al

support.3 Determining the parameters that can lead to the diagnosis of a terminal dentition can be challenging due to the multifactorial nature of compromised denti- tions. For a successful treatment plan, the clinician must be able to avoid both under‑ and overtreatment and decide whether teeth with a favorable prognosis can be selectively maintained.

Treatment Plan

In patients with a compromised dentition, the remaining dentition must be evaluated quantitatively and qualita- tively. Structural damage to the dentition, periodontal damage, the number and distribution of the remaining teeth, and dentogingival and dentofacial esthetics are among the major variables that must be assessed individ- ually. 3 In addition to the remaining dentition, the patient’s level of compliance, financial capabilities, expectations, and wishes must be considered.

Understanding the etiologic factors that resulted in terminal dentition or edentulism is crucial, as this will affect the treatment plan, restoration design, material selection, and prognosis. It is especially important to consider the higher risk of patients with a history of peri- odontitis for developing peri‑implant disease.4

Esthetic Evaluation

Treatment planning for full‑arch implant‑supported res- torations can be an arduous process.5,6 As a starting point, the desired smile esthetics must be determined7 (Fig 6). Today digital smile design can be performed in harmony with a patient’s dentofacial esthetics using arti- ficial intelligence–based software (Smilecloud, Strau- mann). 8 In this case, esthetic analysis was performed by evaluating the smile line, incisal profile, tooth length, in- dividual tooth proportion, tooth‑to‑tooth proportion, gin- gival contours, and fullness of the buccal corridors.6–10

FIG 4 Preoperative intraoral view in occlusion.

FIG 5 Preoperative panoramic radiograph.

FIG 6Digital smile design.

QDT 2025 | Volume 47

5

Pelekanos et al

Virtual Design

First, a 2D digital smile design was created to evaluate smile esthetics (Smilecloud). Subsequently, in the same software a 3D virtual smile design was created to generate a singular design by adding and superimposing the files obtained from the intraoral scan and the files from the CBCT. Figure 7 demonstrates the data sets of the 3D virtual design: initial situation, preoperative situation and singular design, preoperative situ- ation and singular design with bone segmentation, and singular design with bone segmentation. The final data set was used for the virtual implant planning.

Soft and hard tissue dimensional changes after tooth extraction must be considered during the virtual design process.11,12 In the authors’ experience, when the combined thickness of the bone and the soft tissue is more than 2.5 mm at a level measured 5 mm deeper than the clinical crown of the virtual design, the vertical reduction of the soft tissue contour is less than 1 mm (Fig 8). In the present case, because the bone and soft tissue was 2.6 mm thick, the clinical crown of the virtual design was placed approx- imately 1 mm coronal to the gingival margin.

FIG 7 Virtual design of the FP1 prostheses. (1) Preoperative situation. (2) Preoperative situation and singular design. (3) Preoperative situation and singular design with bone segmentation. (4) Singular design with bone segmentation.

FIG 8 Analysis showing the measurements performed for the initial design.

QDT 2025 | Volume 47

6

Pelekanos et al

Virtual Implant Planning

An implant planning software (MGuide, MIS Dental Implants) was used to register the CBCT with the virtual models that were obtained from the intraoral scan to facilitate the prosthetically driven planning of eight implants (V3, MIS Dental Implants) in the maxilla (Figs 9 and 10) and six implants in the mandible13 (Figs 11 and 12).

FIGS 9 AND 10 Virtual implant planning for the maxilla.

FIGS 11 AND 12 Virtual implant planning for the mandible.

QDT 2025 | Volume 47

7

Tooth- and Soft Tissue– Supported Provisional Restoration (Tripod Bridge)

In the mandible, a staged approach was fol- lowed to enable a smooth transition in the new centric relation. A tooth‑ and soft tissue– supported restoration (tripod bridge) was fabricated by bonding a sintered cobalt- chromium (Co‑Cr) substructure with a milled polymethyl methacrylate (PMMA) overlay14 (Fig 13). Teeth with a hopeless prognosis were extracted, except for the canines (Fig 14). The canines were strategically preserved to support a fixed provisional restoration (Fig 15). A tripod bridge is a valuable option for provisional restorations in patients with posterior partial edentulism. Support is pro- vided by the remaining teeth and either the maxillary tuberosities or the mandibular ret- romolar pads.

FIG 13 Tooth- and soft tissue–supported provisional restoration (tripod bridge).

FIG 14 Occlusal view of the mandible after extraction of the hopeless teeth, leaving the canines in place to support a provisional restoration.

FIG 15 Delivery of the tripod bridge.

Pelekanos et al

Pelekanos et al

Fabrication of Surgical Guides

The information from the virtual implant planning was used to design a set of surgical guides for the maxilla and mandible. The goal was to transfer the virtual implant po- sitions to the respective recipient sites through fully guided surgery. The STAR concept was followed to take advantage of the remaining teeth.15 In this way, strategi- cally remaining teeth or roots can be used to increase the accuracy of static computer‑aided implant placement. Surgical guides were 3D printed (Max, Asiga) using a bio- compatible resin (KeyGuide, Keystone Industries).

For the maxilla, a guide for the insertion of the fixa- tion pins, a guide for implant placement, and a guide for positioning the prefabricated prosthesis were printed (Figs 16 to 18). For the mandible, a stackable system was used, including a base guide, a position- ing guide for the insertion of the anchorage pins and implant placement, and a guide for positioning the prefabricated provisional prosthesis according to the initial virtual design (Fig 19).

FIG 16 Surgical guide for anchor pin drilling in the maxilla.

FIG 17 Surgical guide for implant placement in the maxilla.

FIG 18 Surgical guide for positioning the maxillary prosthesis.

QDT 2025 | Volume 47

9

Pelekanos et al

FIG 19 Set of stack- able surgical guides for the mandible.(1) Initial situation.(2) Base guide (light green) connected with the guide for anchorage pin drilling and implant placement(blue). (3) Base guide.(4) Prosthetic guide(dark green) along with the provisional restoration connected with the base guide. (5) Provisional restoration.

QDT 2025 | Volume 47

10

Implant-Supported Provisional Restorations

Full‑arch provisional prostheses were selected to achieve implant splinting for immediate loading. Prior to initia- tion of the implant surgery, PMMA (Telio CAD LT in shade A1, Ivoclar) FP1 provisional prostheses were milled and stained based on the virtual design. Customized pros- thetic channels were incorporated into the prefabricated prostheses to house the temporary cylinders and facili- tate chairside relining. For each provisional restoration, the transmucosal part was digitally formed, consider- ing the 3D virtual design in relation to soft tissue archi- tecture and bone anatomy with the goal of facilitating development of a scalloped interface.16

Surgical Phase

Tooth extraction was performed followed by guided implant placement. Extraction sockets in implant sites were filled with a mixture of mineralized bone allograft(maxgraft, bottis biomaterials) and deproteinized bovine bone mineral (cerabone, botiss biomaterials) particles, at a ratio of 70:30. In pontic sites, extraction sockets were filled with a collagen cone (collacone, bottis biomaterials) with the goal of main- taining the volume of the extraction socket.

Implant Placement

Implants were placed according to the virtual treatment plan. A fully guided surgical protocol was followed to increase the accuracy between the planned and final positions of the implants and decrease operative time.17

In the maxilla, the first surgical guide (positioning guide) was fitted over the remaining teeth to prepare the recip- ient sites for insertion of the anchorage screws (Fig 20). The implant guide was then secured with fixation pins and used for implant drilling and placement (Figs 21 to 23).

For the mandible, one surgical guide was fabricated to aid fixation of the guide as well as implant drilling and placement. This was connected with a base guide and fitted over the strategically remaining teeth to prepare the recipient sites for the insertion of the anchorage screws and to fix the base guide in place (Fig 24).

For each implant, a surgical primary stability of ≥ 35 Ncm was achieved. After the removal of the last surgical guide, multiunit abutments were seated on the implants with a torque of 30 Ncm.

FIG 20 Drilling for the placement of anchorage pins.

QDT 2025 | Volume 47

11

Pelekanos et al

FIG 21 Provisional prosthesis.

FIG 22 Implant placement through the surgical guide.

FIG 23 Positioning of the provisional FP1 restoration with the prosthetic guide.

FIG 24 Stackable 3D-printed guides for the mandible. (1) Base guide.(2) Base guide connected with positioning/implant placement guide using pins. (3) Base guide connected with the prosthetic guide and the provisional prosthesis.

QDT 2025 | Volume 47

12

Immediate Loading

When implants have a primary stability of at least 25 Ncm, an immediate loading approach, in which the implants and prosthesis are placed the same day, has been favor- ably reported in the literature with high success rates.18,19

After implant placement, temporary cylinders were inserted and a specially designed prosthetic guide was used to position the prefabricated FP1 provisional pros- thesis according to the virtual treatment plan and to facilitate the engagement of temporary cylinders.

In the maxilla, the implant guide was removed, and the prosthetic guide was fixed using the same anchorage screws (see Fig 22). In the mandible, the prosthetic guide was inserted over the base guide using fixation pins.

The surface of the prosthetic channels was modified by airborne‑particle abrasion with 50‑μm Al2O3 particles under

a pressure of 2.5 bars, followed by application of a phos- phate monomer primer (Monobond Plus, Ivoclar). Rubber dam foils were used to isolate the surgical field around the base of each temporary cylinder. Subsequently, a flowable composite (Tetric A1 Evoflow, Ivoclar) was injected into each prosthetic channel for connection with the equiva- lent temporary cylinder. After the excess composite resin was cured, the provisional prosthesis was removed and the emergence profile further developed. Finally, the transmu- cosal surface was mechanically polished (see Fig 23).

Each provisional prosthesis was screwed onto the multi- unit abutments at 15 Ncm, and the patient was informed about the postoperative medications, diet, and recall sched- ule at the same appointment. Figures 25 and 26 show the status of the soft tissues 4 weeks after suture removal.

FIG 25 Intraoral frontal view of the maxilla 4 weeks after suture removal.

FIG 26 Intraoral frontal view of the mandible 4 weeks after suture removal.

Pelekanos et al

Functional Evaluation

The patient’s maxillomandibular relationship and envelope of function were evaluated using an optical jaw‑tracking system (Twim, Modjaw). Centric relation was selected as the treatment position, and a mutually protected occlusal scheme was considered. Posterior restorations were designed to protect the anterior resto- rations in centric relation. Through the anterior guidance, sufficient disocclusion of the posterior restorations in harmony with the patient’s envelope of function was provided to protect the posterior restorations during protrusive and lateral excursive movements (Fig 27). During the lateral excursive movements, the canines and first premolars were selected to articulate.20

Digital Implant Position Acquisition

Four months after the initial placement of the implants, an intraoral scanner (Trios 3, 3Shape) was used to record the implant position (Figs 28 and 29). In total, four scans were obtained for each jaw to create the required digital data- set: (1) a scan of the soft tissue after removal of the provi- sional prosthesis, (2) a scan with the scan bodies in place, (3) a scan of the provisional prosthesis fixed intraorally, and (4) a scan of the provisional prosthesis extraorally.

FIG 27 Evaluation of the maxillomandibular relationship and envelope of function using an optical jaw-tracking system (Modjaw).

FIG 28 Occlusal view of the maxilla with scan bodies in place.

FIG 29 Frontal view of the mandible with scan bodies in place.

QDT 2025 | Volume 47

14

Pelekanos et al

Provisional restorations were scanned both extra‑ and intraorally with the goal of compensating for the collapse of the gingival tissue and capturing the overall contour of the restoration, particularly its transmucosal surface in pontic sites as well as the emergence profiles.21

Passive seating was achieved for all restorations. A screw resistance test was performed for each prosthesis to confirm passive fit. In the present case, the limitations of conventional intraoral scanning of full‑arch implant posi- tions were diminished because instead of one full‑arch prosthesis, three segmented restorations were fabricated.

Prosthesis Material Selection, Design, and Fabrication

Prostheses were fabricated out of monolithic zirconia using the virtual design as a reference.22,23 A polychro- matic, layer‑free gradient zirconia (IPS e.max ZirCAD Prime in shade A1) was selected for the definitive resto- rations, featuring polycrystalline 3% mol yttria–stabilized tetragonal zirconia (3Y‑TZP) at the dentin side of the disk and 5Y‑TZP at the incisal side. In this way, the mechan- ical characteristics of 3Y‑TZP opaque zirconia (flexural strength of 1,200 MPa reported by the manufacturer) were combined with the esthetics of 5Y‑TZP translucent zirconia (flexural strength of 650 MPa reported by the manufacturer). In the presence of a cantilever, the zirco- nia overlay is supported by an anatomically shaped tita- nium superstructure.24,25

Prior to fabrication of the definitive prostheses, a set of prototype prostheses was 3D printed (Max) using resin for try‑in restorations (KeyDenture in shade A1, Keystone Industries) to verify the design of the definitive prosthe- ses (Figs 30 and 31). Through the additively manufactured prototypes, the smile esthetics, phonetics, occlusion, and fit of the restorations were verified. For zirconia titanium- supported prostheses, prototypes of titanium frame- works and the zirconia overlays were 3D printed to verify their fit intraorally. After try‑in, prototype prostheses were scanned extraorally to digitize and incorporate the modifi- cations caried out intraorally into the virtual design.21

FIG 30 3D-printed prototype restorations for the maxilla.

FIG 31 3D-printed prototype restorations for the mandible.

QDT 2025 | Volume 47

15

Pelekanos et al

Definitive monolithic zirconia restorations were milled without a cutback to reduce the incidence of ceramic chipping.26 Only external 3D staining was performed using a universal range of stain and glaze materials (Ivocolor Vivadent IPS) to achieve a natural appearance. A 9‑hour sintering cycle was performed to increase the translucency of the restorations and achieve better mechanical properties.27,28 Slow cooling was also performed.26 Monolithic zirconia prostheses and titanium superstructures were designed, taking into consideration the virtual design and emergence profiles shaped by the provisional prostheses. Figures 32 to 35 show the final scalloping of the soft tissue architecture. The intaglio surfaces of the definitive prostheses were slightly overextended, about 1 mm toward the soft tissue, to achieve active pressure and compensate for any loss during mechanical polishing.29

FIG 32 Occlusal view of the maxillary soft tissue.

FIG 33 Occlusal view of the mandibular soft tissue.

FIG 34 Lateral view of the maxillary soft tissue.

FIG 35 Frontal view of the mandibular soft tissue.

Pelekanos et al

Titanium bases were used to connect the monolithic zirconia prostheses with multiunit abutments, but for the titanium‑supported zirconia prostheses, titanium bases were not used because the connection between the prostheses and the multiunit abutments was achieved through the titanium framework. The metal substruc- ture was milled from a titanium block (Colado CAD Ti5, Ivoclar) and anatomically shaped, leaving at least 2 mm of clearance for the zirconia overlay. The overlay- ing zirconia was designed to fit passively with the metal substructure, achieving a flawless finish line and avoid- ing any undercuts (Figs 36 and 37). The restorations were subsequently verified intraorally (Figs 38 and 39).

FIG 36 Definitive maxillary prosthesis prior to bonding of the zirconia overlay with the titanium substructure.

FIG 37 Definitive mandibular prosthesis prior to bonding of the zirconia overlay with the titanium substructure.

FIG 38 Try-in of the definitive maxillary prosthesis with monolithic zirconia restorations in the anterior and titanium substructures in the posterior areas.

FIG 39 Try-in of the definitive mandibular prosthesis with a titanium substructure in the anterior mandible and monolithic zirconia restorations in the posterior areas.

QDT 2025 | Volume 47

17

Pelekanos et al

The intaglio surface of the zirconia superstructure was airborne‑particle abraded with 50‑μm Al2O3 particles under a pressure of less than 2 bars at a distance of 2 cm. The metal counter- part was airborne‑particle abraded with 110‑μm Al2O3 particles under a pressure of 2.5 bars. After thorough rinsing and air drying of the two parts, a primer (Monobond Plus) was applied to the respective surfaces. Finally, the zirconia overlay was bonded with the titanium super- structure using a self‑curing luting composite (Multilink Hybrid Abutment, Ivoclar).30 After the bonding procedure, any remnants at the interface between the two counterparts were mechanically removed and the surface was polished (EVE Diacera Diamond Rubber, Eagle Dental Burs). Before bonding the titanium bases with the monolithic zirconia prostheses, they were airborne‑particle abraded with 50‑μm Al2O3 particles under a pressure of 2.5 bars.31 Any remnants of cement at the finish line were carefully removed, and the surface was polished mechanically. The final prostheses were decontaminated in an ultrasonic bath with an isopro- panol solution and then steam cleaned (Figs 40 to 42).

FIG 40 Definitive restorations in occlusion on the 3D-printed model after bonding of the zirconia with the titanium counterparts.

FIG 41 Definitive maxillary prosthesis.

FIG 42 Definitive mandibular prosthesis.

QDT 2025 | Volume 47

18

Pelekanos et al

Delivery of Definitive Restorations and Follow-up

Restorations were torqued in place, the occlusion was verified, and the screw access channels were filled with medical‑grade polytetrafluoroethylene tape (i‑Plug,

Applied Dental). Figures 43 to 46 show the delivery of the definitive restorations. Subsequently, the zirconia surface was treated with a primer (Monobond Plus) and an adhesive (Adhese Universal, Ivoclar), followed by the application of a composite (IPS Empress Direct in shade A1 Dentin, Ivoclar).

FIG 43 Occlusal view of the definitive posterior restorations in the maxilla.

FIG 44 Occlusal view of the definitive anterior restorations in the maxilla.

FIG 45 Occlusal view of the definitive restorations in the mandible.

FIG 46 Frontal view of the definitive restorations in the maxilla.

QDT 2025 | Volume 47

19

Final intraoral (Figs 47 to 51), extraoral (Figs 52 to 54), and radiographic (Fig 55) views of the restorations were captured. After the follow‑up appointments at 1, 4, and 12 weeks, the patient was scheduled for periodic maintenance every 6 months.

FIGS 47 TO 51 Final intraoral views